What are the initial steps for emergency department care?

Updated: Apr 09, 2021
  • Author: Spencer Greene, MD, MS, FACEP, FACMT, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
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Once the patient has arrived at the hospital, definitively manage any life-threatening airway, breathing, and circulatory issues. Airway patency may be compromised in severe envenomations or in the rare case of anaphylaxis in response to snake venom. Epinephrine should be administered to anyone with anaphylaxis, and intubation should be performed if patients do not respond. Intubation is also necessary for patients who have impaired ventilation secondary to respiratory muscle weakness. Intravenous fluid resuscitation may be needed to restore euvolemia in patients with significant hypovolemia secondary to gastrointestinal losses and/or third-spacing. Excessive fluid administration should be avoided because it can theoretically exacerbate tissue swelling.

Analgesia is an essential component to snakebite management. Intravenous opioids are preferred initially. NSAIDs are discouraged because of the potential hematologic effects.

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